0500

dear muffin,

it's dark at 0500 hours. dark & cold. bursting out of the revolving door and into the hospital is always a relief: warmth, light, & the smell of cafeteria coffee rush forward. 

this morning was no different. in a blink I found myself walking around an oncology unit with the night-shift nurse & the oncoming day nurse. my pen tried valiantly to keep up with a steady stream of patient information, IV drip rates, recent vital signs, & critical lab values as the night-shift nurse delivered her report.

slipping into the first room, I peered through the darkness and detected a shallow rise & fall beneath the bed linens. lying on the bed amidst blinking monitors & an IV pump was a man younger than my father.

"former army doctor. stationed in the middle east." the night-nurse says. "he contracted hepatitis while working there; he's terminal now. comfort care only... there's nothing more we can do for him." 

I watched as the IV pump's blue light blinked across his face. it must be nearly impossible to sleep with so many distractions: lights, beeps, blinks, alarms. nurses checking on him, talking in his room. talking about him. 

we moved to the next room, and I gently closed the door behind us. the nurse was talking again.

"...and here's 11A: he's septic. history of cancer of the head, neck, esophagus, liver, & kidney. his magnesium level is down to 1.2 this morning." she gave the oncoming nurse an exasperated expression. "the doctor's been steadily increasing his dosage, but he just keeps dropping. we don't know what's going on." 

the little old man craned his neck out of the bed linens. his head was wrapped snuggly in a knit beanie. 

"eh? you're who?" he said when I introduced myself. "oh, hi kristen-the-nursing-student. it's not wednesday anymore." he cocked his head & glared at me.

I must have looked uncertain.

"THAT!" he said, pointing to the whiteboard opposite his bed. a preprinted calendar had been attached, and "wednesday" was circled in blue dry erase marker, followed by yesterday's date.

"oh! no, it certainly isn't wednesday anymore. here, let me fix it for you." I rubbed out the old date & circled thursday, then added my name beside the nurse's. suddenly I was struck by how much my signature looked like a kid's, squeezed in beside the nurse's official-looking scrawl.

the nurses had already left me behind, marching on to the next room & the next patient. I walked over to the man's bed and & gave him a big smile. 

his eyes were surprisingly clear. pained, but bright. in them I could see the toughened weariness that comes with long medical battles. his chart had told me that this was the fourth time he'd been hospitalized with sepsis in the last ten years. this time they'd had to insert a chest tube. [which is exactly as unpleasant as it sounds.] as soon as the tube was in place, 3 liters of infected fluid came flooding out of his lung cavity. I didn't even know there was room for 3 liters of fluid inside the lung cavity.

a portion of my mind began a routine assessment of the man. airway open; oxygen running smoothly at 2 L, nasal cannula. wheezing. a coarse cough that sounded like it could drown him at any moment. breathing so labored that it made his abdomen heave with the effort. but eyes bright, and locked onto mine.

"I'll be back in a little while," I said. "...but is there anything I can do for you right now?"

do for me? those eyes asked. what can you do for me?

"nah," the man said. "I'm fine. thanks, though."

I spent the rest of the shift trying to do something for him. I'd like to think I brightened his day; made him more comfortable, explained something that had confused him. for 6 hours, his problems were my problems & my sole responsibility was to help him through the day.

but at the end of every shift, I go home. I share my stories with my family while heating up leftovers for a late lunch. stories. that's what the patients become.

"oh, you shoulda been here last night." the nurse said when I joined her back at the nurse's station. "I had to call a code on 504A. I saw her heart monitor go flat, so I figured her chest leads had just fallen off... but I walked into the room & she was all slumped over. blue. she had a 'do not resuscitate' order in her chart, so we couldn't even touch her. the entire code team had to just stand there & watch as she died." the nurse sipped her starbucks & went back to charting.

my patient could code tonight. he could stop breathing & never start again, like the patient in 504A. I would never hear about it. from now until forever, he's a story to me. just like 504A is now a story to that nurse.

it's a strange business. 

and on that cheery note, I toddle off to bed. count your blessings as you fall asleep... at the top of my list tonight are 1) health. this may sound funny coming from a girl who currently sports a fever. but a day in the hospital never ceases to drive me to thankfulness. I could have lymphoma, heart failure, brain tumor! amyotrophic lateral sclerosis, Hashimoto's encephalopathy, schizophrenia! but all I have is a slight, non-threatening elevation of body temperature that will most likely resolve itself in under 48 hours. gah.

2), this amazing planet God has given us. if you haven't watched this video yet, go do it. http://www.danoah.com/2011/11/the-most-amazing-time-lapse-video-ive-ever-seen.html

and 3), the heroes who daily risk their lives for ours. may we never take for granted the sacrifices they make for us.

always,

rory